title: Impact of a program of physiotherapy and health education on the outcome of obstetric fistula surgery.
abstract: OBJECTIVE
  Surgery is the only successful treatment for most obstetric fistulae. The present study measured the impact of a structured program of pre- and postoperative physiotherapy and health education on the outcome of surgery for obstetric fistula.
  
  
  METHODS
  We compared the postoperative outcomes of 2 consecutive groups of women with obstetric fistulae who were recruited and followed-up by 2 local nongovernmental organizations at a hospital in Tanguiéta, Benin. The first group of women (n=99) had fistula repair using standardized techniques. The second group (n=112) had a standardized surgical approach plus a structured program of pre- and postoperative health education and physiotherapy.
  
  
  RESULTS
  The program had a significant positive impact on recovery in general and on urinary incontinence in particular. After physiotherapy, the odds of recovery were 2.72 times greater for women in the physiotherapy group than for control patients, and the probability of postoperative stress incontinence was considerably higher for patients in the control group than for those in the physiotherapy group (P<0.001).
  
  
  CONCLUSIONS
  A structured program of health education and physiotherapy by experienced nurses and physiotherapists improves the likelihood of a successful outcome after surgical repair of obstetric fistula.
authors.affiliation: Rehabilitation Department, Cliniques Universitaires St Luc, Brussels, Belgium. Electronic address: yves.castille@uclouvain.be.
authors.forename: Yves-Jacques
authors.initials: YJ
authors.lastname: Castille
authors.affiliation: Rehabilitation Department, Hôpital St Jean de Dieu, Tanguiéta, Bénin.
authors.forename: Chiara
authors.initials: C
authors.lastname: Avocetien
authors.affiliation: Gynecology Department, Hôpital St Jean de Dieu, Tanguiéta, Bénin.
authors.forename: Dieudonné
authors.initials: D
authors.lastname: Zaongo
authors.affiliation: Urology Department, Polyclinique du Parc, Dole, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Colas
authors.affiliation: Vattikui Urology Institute, Henry Ford Hospital, Detroit, USA.
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.affiliation: Urology Department, Clinique Générale Beaulieu, Geneva, Switzerland; Albert Einstein College of Medicine, New York, USA.
authors.forename: Charles-Henry
authors.initials: CH
authors.lastname: Rochat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005081:Exercise Therapy; D005260:Female; D006266:Health Education; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014719:Vesicovaginal Fistula / Q000534:rehabilitation* / Q000601:surgery; D055815:Young Adult
keywords: Health education; Obstetric fistula; Physiotherapy; Rehabilitation; Urinary incontinence